Provider Demographics
NPI:1932276003
Name:NOVATO FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:NOVATO FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-897-3914
Mailing Address - Street 1:7460 REDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2457
Mailing Address - Country:US
Mailing Address - Phone:415-897-3914
Mailing Address - Fax:415-898-6677
Practice Address - Street 1:7460 REDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2457
Practice Address - Country:US
Practice Address - Phone:415-897-3914
Practice Address - Fax:415-898-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438411223G0001X
CA465901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty